Provider Demographics
NPI:1730221474
Name:DUCOUDRAY, SAMADYS N (MD)
Entity type:Individual
Prefix:DR
First Name:SAMADYS
Middle Name:N
Last Name:DUCOUDRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7738
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7738
Mailing Address - Country:US
Mailing Address - Phone:787-744-5208
Mailing Address - Fax:787-744-5208
Practice Address - Street 1:HOSPITAL HIMA SUITE 133
Practice Address - Street 2:LUIS MNOZ MARIN AVENUE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-5208
Practice Address - Fax:787-744-5208
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR121492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41335Medicare UPIN